A Population-Based Prospective 24-Month Study of Stroke: Incidence and 30-Day Case-Fatality Rates of First-Ever Strokes in Croatia

2012 ◽  
Vol 38 (3) ◽  
pp. 164-171 ◽  
Author(s):  
Slaven Pikija ◽  
Danijel Cvetko ◽  
Branko Malojčić ◽  
Zlatko Trkanjec ◽  
Ivan Pavliček ◽  
...  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Melissa C. MacKinnon ◽  
Scott A. McEwen ◽  
David L. Pearl ◽  
Outi Lyytikäinen ◽  
Gunnar Jacobsson ◽  
...  

Abstract Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.


Stroke ◽  
2005 ◽  
Vol 36 (12) ◽  
pp. 2738-2741 ◽  
Author(s):  
Rosa Musolino ◽  
Paolino La Spina ◽  
Salvatore Serra ◽  
Paolo Postorino ◽  
Salvatore Calabró ◽  
...  

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Luciano Sposato ◽  
Gustavo Saposnik

Background: Differences in definitions of socioeconomic status (SES) and between study designs hinder their comparability across countries. We aimed to analyze the correlation of three widely used macro-SES indicators with stroke incidence and age at stroke onset. Methods: We selected population-based studies reporting incident stroke risk and/or 30-day case fatality according to pre-specified criteria. We used three macro-SES indicators that are consistently defined by international agencies: per capita gross domestic product adjusted for purchasing power parity (PPP-aGDP), total health expenditures per capita at purchasing power parity (PPP-aTHE) and unemployment rate. We used two-tailed Spearman’s test and scatter-plots for analyzing the correlation of each macro-SES indicator with incident risk of stroke, 30-day case fatality rates, proportion of hemorrhagic strokes and age at stroke onset. Results: Twenty-three manuscripts comprising 30 population-based studies fulfilled the eligibility criteria. Age-adjusted incident risk of stroke using standardized World Health Organization World population, 30-day case fatality rates, proportion of hemorrhagic strokes and age at stroke onset were associated to lower PPP-aGDP and PPP-aTHE ( Table 1 and Figures 2 and 3). There was no correlation between unemployment rates and outcome measures. Table 1. Correlation Analyses of Macro-Indicators of Socioeconomic Status Figures 1. Scatter Plots for PPP-aGDP Figures 2. Scatter Plots for PPP-aTHE Conclusions: Lower PPP-aGDP and PPP-aTHE were associated with higher incident risk of stroke, higher case fatality, greater proportion of hemorrhagic strokes and lower age at stroke onset. As a result, these macro-SES indicators may be used as proxy measures of quality of primary prevention and acute care and considered as important factors for developing strategies aimed at improving worldwide stroke care.


Stroke ◽  
1995 ◽  
Vol 26 (6) ◽  
pp. 924-929 ◽  
Author(s):  
Valery L. Feigin ◽  
David O. Wiebers ◽  
Jack P. Whisnant ◽  
W. Michael O’Fallon

Stroke ◽  
2019 ◽  
Vol 50 (10) ◽  
pp. 2661-2667 ◽  
Author(s):  
Olivier Grimaud ◽  
Yacine Lachkhem ◽  
Fei Gao ◽  
Cindy Padilla ◽  
Mélanie Bertin ◽  
...  

Background and Purpose— Recent findings suggest that in the United States, stroke incidence is higher in rural than in urban areas. Similar analyses in other high-income countries are scarce with conflicting results. In 2008, the Brest Stroke Registry was started in western France, an area that includes about 366 000 individuals living in various urban and rural settings. Methods— All new patients with stroke included in the Brest Stroke Registry from 2008 to 2013 were classified as residing in town centers, suburbs, isolated towns, or rural areas. Poisson regression was used to analyze stroke incidence and 30-day case fatality variations in the 4 different residence categories. Models with case fatality as outcome were adjusted for age, stroke type, and stroke severity. Results— In total, 3854 incident stroke cases (n=2039 women, 53%) were identified during the study period. Demographic and socio-economic characteristics and primary healthcare access indicators were significantly different among the 4 residence categories. Patterns of risk factors, stroke type, and severity were comparable among residence categories in both sexes. Age-standardized stroke rates varied from 2.90 per thousand (95% CI, 2.59–3.21) in suburbs to 3.35 (95% CI, 2.98–3.73) in rural areas for men, and from 2.14 (95% CI, 2.00–2.28) in town centers to 2.34 (95% CI, 2.12–2.57) in suburbs for women. Regression models suggested that among men, stroke incidence was significantly lower in suburbs than in town centers (incidence rate ratio =0.87; 95% CI, 0.77–0.99). Case fatality risk was comparable across urban categories but lower in rural patients (relative risk versus town centers: 0.76; 95% CI, 0.60–0.96). Conclusions— Stroke incidence was comparable, and the 30-day case fatality only slightly varied in the 4 residence categories despite widely different socio-demographic features covered by the Brest Stroke Registry.


2019 ◽  
Vol 48 (3-6) ◽  
pp. 149-156 ◽  
Author(s):  
Peter Appelros

Background and Purpose: A stroke incidence study in ­Örebro, situated in Southern Sweden, that was carried out in 1999 showed high incidence rates. Since then, in many Western countries, declining incidence rates have been observed. The main purpose of this study is to examine whether there have been any changes in stroke incidence in the city of ­Örebro between 1999 and 2017. Secondary purposes are to show trends in stroke severity, length of stay and case fatality (CF). Methods: The criterion of an “ideal” stroke incidence study was used in both the 1999 and the present investigation. These criteria include uniform diagnostics, case ascertainment including strokes managed outside the hospital, and the use of several overlapping sources, prospective design, well-defined denominator, and a large population. Results: The overall stroke incidence rate of first ever stroke (adjusted to the 2013 European population) dropped from 346/100,000 (95% CI 314–380) to 168/100,000 (95% CI 148–190). Stroke severity declined from a median of 6 to 4 points on the National Institute of Health Stroke scale. CF within 28 days also declined from 19 to 16% (n.s.). Median length-of-stay in hospital was 16 days in 1999, and 10 days in 2017. Twenty-one per cent of all kinds of stroke were recurrent (not included in the above results). Conclusions: During the years between 1999 and 2017, there have been reductions in stroke incidence, severity and mortality. The explanation is most likely to be found in the prevalence of risk factors and how they are treated. The use of antihypertensives and statins has increased, corresponding to lower levels of blood pressure and cholesterol in the population. The use of anticoagulants in patients with atrial fibrillation has increased. Cigarette smoking has decreased. These are encouraging results that show that preventive medication and public health measures work in practice.


2009 ◽  
Vol 8 (4) ◽  
pp. 355-369 ◽  
Author(s):  
Valery L Feigin ◽  
Carlene MM Lawes ◽  
Derrick A Bennett ◽  
Suzanne L Barker-Collo ◽  
Varsha Parag

2013 ◽  
Vol 8 (SA100) ◽  
pp. 100-105 ◽  
Author(s):  
Francesco Janes ◽  
Gian Luigi Gigli ◽  
Lucio D'Anna ◽  
Iacopo Cancelli ◽  
Anna Perelli ◽  
...  

2020 ◽  
pp. 1-6
Author(s):  
Enrico Giordan ◽  
Christopher S. Graffeo ◽  
Alejandro A. Rabinstein ◽  
Robert D. Brown ◽  
Walter A. Rocca ◽  
...  

OBJECTIVERecent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors.METHODSThe population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996–2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use.RESULTSOne hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16–94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011–2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006–2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018.CONCLUSIONSA decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.


Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1173-1179 ◽  
Author(s):  
Anne Merete Vangen-Lønne ◽  
Tom Wilsgaard ◽  
Stein Harald Johnsen ◽  
Maria Carlsson ◽  
Ellisiv B. Mathiesen

Background and Purpose— Ischemic stroke incidence has declined in industrialized countries the last decades, with possible exception for the youngest age groups. We estimated age- and sex-specific trends in incidence and case fatality of first-ever ischemic stroke between 1977 and 2010 in a Norwegian municipality. Methods— Age-adjusted time trends in incidence from 1977 to 2010 were estimated by fractional polynomial and Poisson regression, and case fatality by logistic regression in 36 575 participants of the population-based Tromsø Study. Results— There were 1214 first-ever ischemic strokes within a total follow-up time of 611 176 person-years. The overall age- and sex-adjusted incidence decreased by 24% in 1995 to 2010. In women aged 30 to 49 years, the incidence increased significantly from 1980 to 2010. In men aged 30 to 49 years, there was a nonsignificant, rising trend from 1977 to 2010. Men aged 50 to 64 years had similar incidence in 2010 compared with 1989. From the mid-1990s to 2010, the incidence declined significantly in women aged 50 to 74 years and in men aged 65 to 74 years, but remained stable in those aged ≥75 years. Case fatality decreased significantly in men aged 30 to 84 years from 1995 to 2010, whereas there was no significant change in women. Conclusions— Age-adjusted incidence of first-ever ischemic stroke increased in young women, declined in women aged 50 to 74 years and men aged 65 to 74 years and remained stable among the oldest. Case fatality declined in men aged 30 to 84 years, but not in women.


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